Introduction: Computerized intravenous (IV) insulin infusion calculators may offer a safe and efficacious means of achieving glycemic control. Historically, our health system utilized various multiplication factor and fixed-dose, paper-based IV insulin infusion protocols, but transitioned to a computerized insulin infusion calculator protocol based on the insulin sensitivity coefficient (ISC) in 2024. The objective of this study was to compare the safety and efficacy of the computerized ISC-based insulin infusion calculator protocol with the previous protocols. Methods: This was a pre-post intervention analysis (IRB Protocol #2023P002213) of adult patients initiated on a paper-based insulin infusion across 13 institutions from March 2023 to May 2023 for pre-analysis and patients on a computerized, ISC-based insulin infusion from November 2024 to December 2024 for post-analysis. Patients were excluded if the indication was hyperglycemic emergencies, hypertriglyceridemia, hyperkalemia, or hyperglycemia management in obstetric patients. The major endpoint was the percentage of blood glucose levels within target range (80-180 mg/dL). Secondary outcomes included rates of hyperglycemia (>200 mg/dL), severe hyperglycemia (>250 mg/dL), hypoglycemia (< 70 mg/dL), and severe hypoglycemia (< 54 mg/dL). Results: In total, 503 patients were evaluated for inclusion, of which 207 and 237 patients were included in the pre-intervention and post-intervention groups, respectively. The most common reason for exclusion was the use of IV insulin for hyperglycemia emergencies. A total of 14,183 blood glucose values were assessed between the pre- and post-intervention groups. For the major outcome, 4,610 of 6,313 (73%) and 6,163 of 7,870 (78.3%) of blood glucose values were in range in the pre- and post-intervention groups, respectively (p< 0.01). There was no statistical difference in severe hypoglycemia (0.2% vs. 0.1%, p=0.24), but hyperglycemia (16.6% vs. 12.6%, p< 0.01), severe hyperglycemia (5.7% vs. 4.0%, p< 0.01), and hypoglycemia (0.7% vs. 0.2%, p< 0.01) were significantly more common in the pre-intervention group. Conclusions: A computerized ISC-based insulin infusion protocol resulted in more blood glucose values within target range and lower rates of hypoglycemia compared to paper-based IV insulin infusion protocols.
Janowski et al. (Sun,) studied this question.